Acute chest pain without obvious organic cause before the age of 40. Respiratory and circulatory response to mental stress.

Reactivity to mental stress and relaxation was studied in 63 consecutive patients below the age of 40 attending the emergency care unit because of chest pain without obvious organic cause. The results were compared with a control group (n = 32). Of the patients, 41% reported chest pain or oppression in the chest during mental stress compared to 10% of the control subjects (p less than 0.01). During relaxation the subjects in the female patient group reported significantly less ability to relax and had significantly higher respiration rate as compared to the female control group. There were no significant differences between the groups regarding heart rate, blood pressure or end-tidal PCO2 and there was no evidence of hyperventilation, neither during relaxation nor during mental stress. In combination with our earlier findings of high scores for "type A behaviour", "neuroticism", "vital exhaustion" and "stressful life events" these findings indicate that psychosomatic mechanisms may be of great importance for the development of chest pain in this group of patients.